Summary: Mrs X complained the care provider continued to provide double handed care calls when she needed single handed calls and cancelled the care without notice. The care provider was at fault for the lack of clarity about the support it was providing to Mrs X and its lack of records. This caused Mrs X confusion. The care provider should reduce the bill and review its record keeping procedures. It was not at fault for cancelling the contract or for continuing with double handed care after a reassessment.

The complaint

1. Mrs X complained the care provider continued to provide, and bill her for, double handed care calls when she had repeatedly requested and needed single handed calls. It has continued to pursue her for the care costs which Mrs X is not willing to pay. In addition, Mrs X says it cancelled the care without notice leaving her without the support she required.

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The Ombudsman’s role and powers

2. We investigate complaints about adult social care providers and decide whether their actions have caused an injustice, or could have caused injustice, to the person making the complaint. I have used the term fault to describe such actions. (Local Government Act 1974, sections 34B and 34C)
3. If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
4. If we are satisfied with a care provider’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

5. I have considered the information provided by Mrs X in writing and on the phone. I have considered the care provider’s response to my enquiries.
6. I gave Mrs X and the care provider the opportunity to comment on a draft of my decision. I considered their comments before I reached a final decision.
7. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share this decision with CQC.

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What I found

8. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards those registered to provide care services must achieve. The Care Quality Commission (CQC) has issued guidance on how to meet the fundamental standards which care must never fall below
9. Regulation 17, says care providers should securely maintain accurate, complete and detailed records in respect of each person using the service ‘including a record of the care and treatment provided to the service user and of decisions taken in relation to the care and treatment provided’.

What happened

10. Mrs X has disabilities and uses a wheelchair. After a number of falls Mrs X’s GP referred her for a period of NHS funded respite in a nursing home. Following this, in February 2019, she started to receive a care package of two half hour double handed (i.e. two carers) visits a day. The care provider says this was a referral from a charity for double handed care calls and so was put in place.
11. Two staff from the care provider visited Mrs X to assess her at the nursing home. Mrs X says they did not assess her or her ability to use a turntable to move to and from the wheelchair.
12. The care provider says it gave Mrs X a copy of the contract and care plan. It says Ms X kept these in a file at her house and has not returned them to it. Mrs X says the care plan she has, under services required, sets out the support she needed with transfers, and assistance with dressing, but made no reference to the number of carers required or the length of the calls.
13. The care provider has provided me with a specimen contract which sets out that a notice period of seven days will be given if it finds it necessary to withdraw the service. The contract sets out that the care provider will provide care services ‘as described in the service user’s care plan, a copy of which is kept in the service user’s file and has been signed by the service user’.
14. Mrs X says, when carers visited, she told them verbally she did not need two staff. The care provider contacted Mrs X in mid-March to review how the service was going. Mrs X raised her concerns and two staff visited her in late March 2019. At the visit they carried out a reassessment and agreed Mrs X could be supported by one carer. The care provider says it explained it had no capacity to provide a single carer at the times Mrs X wanted. It says Mrs X opted to keep the double handed calls so she could receive an earlier call time. Mrs X says there was never any discussion about call times. She says she explained she would not pay for double handed calls when she did not need them. The care provider says it moved Mrs X onto a single run in the mornings when it had capacity to do so.
15. The care provider sent me an undated assessment document. This states Mrs X required ‘minimal support from the care staff’. Under ‘outcome to be achieved through provision of support’ it stated, ‘to ensure a good standard of personal hygiene is maintained’. Under services required it stated ‘09:30am x 7 x 2 carer’ in the morning and ‘09.30am x 7 x 2 carer’ at bedtime. Later in the document under services required it stated under mornings that Mrs X requires ‘single 30 mins x 7 days’. Under the bedtime section it stated ‘double 30 mins x 7 days’.
16. Mrs X refused to pay the care bills. The care provider says it wrote to Mrs X on 24 April 2019 following a telephone conversation that day. The letter stated ‘following our conversation earlier today this is written notice and reminder. Failure to pay the outstanding amount will result in legal proceedings being undertaken to recover the outstanding balance. Failure to pay will result in care being ended in 7 days’ time, unless the full amount owed is paid in full’. Mrs X says she did not receive this letter.
17. The care provider telephoned Mrs X on 1 May to ask for payment. The care provider says it told Mrs X that care would stop as per the notice. Mrs X did not agree to pay the invoice. On 2 May 2019 the care provider carried out the care calls. Mrs X did not receive any care visits on 3 May. She says she had to ask friends for support before engaging a new care provider the following week. Mrs X has not paid the care bills.

Findings

18. The care provider has been unable to provide me with a copy of the contract or care plan from the initial assessment of Mrs X. Mrs X says the care plan in the file makes no reference to double handed visits. The care plan the care provider has supplied refers to two carers visiting twice a day in an early section and later refers to one carer in the morning and two at bedtime in a later section. This lack of clarity and the lack of records is a breach of the fundamental standards and is fault. Without accurate records I cannot know exactly what the care provider told Mrs X about the support she would receive. I have seen no evidence that Mrs X was aware of and agreed to double handed care visits.
19. Two carers visited Mrs X and she was invoiced on that basis. When Mrs X raised concerns the care provider carried out a reassessment and agreed Mrs X could manage with one carer rather than two. The care provider says it did not have capacity to provide one carer at the times Mrs X wanted. Mrs X was on a ‘double run’ and so continued to be charged for two carers. Mrs X says there was no discussion about call times. Mrs X says she refused to pay for a double call as she did not need it.
20. It was open to Mrs X to give notice if she was unhappy with the level of support provided and if she did not want to pay for a visit by two carers. Following the reassessment, Mrs X was aware she was on a double handed call run and continued to accept the care. She was billed correctly for the care she received. The care provider was not at fault for continuing to provide two carers and invoicing Mrs X for the care.
21. The care provider has provided a copy of the letter it sent Mrs X giving seven days written notice to Mrs X. Mrs X says she did not receive this letter. I cannot say why Mrs X did not receive the letter, but I cannot say that it is the care provider’s fault. In any case, the care provider also telephoned Mrs X to advise her it was stopping the care. It acted in line with its terms and conditions and was not at fault for ending the contract when Mrs X refused to pay the invoices.

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Agreed action

22. Within one month of my final decision on the complaint the care provider has agreed to recalculate Mrs X’s bill, charging her for one carer for each visit from the start of the care package in February 2019 until the review visit in March 2019 due to the lack of evidence she agreed to double handed care visits before this date.
23. Within two months of the final decision the care provider should review its procedures to ensure it retains a copy of all contracts and care plans in line with the fundamental standards. It should provide evidence to the Ombudsman that it has done this.

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Final decision

24. I have completed my investigation. On the evidence considered the care provider was at fault causing Mrs X an injustice for which I have recommended a remedy.

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Investigator's decision on behalf of the Ombudsman